Confidential, Comprehensive, Personal & Financial Profile Step 1 of 5 - Family and Occupation 0% Family InformationMarital Status* Single Married Divorced Widowed First Name* Last Name* Date of Birth* SSN* Spouse's First Name* Spouse's Last Name* Spouse's Date of Birth* Spouse's SSN* Wedding Anniversary Date* Residential Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address* Uncheck if your Mailing Address is different than Residential Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Contact Method*Home PhoneCellEmailHome PhoneCell Phone*Spouse's Cell*Email* Spouse's Email* OccupationEmployment Status* Employed Retired Your Job Title* Employer Name* Employment Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Retirement Date Spouse's Employment Status* Employed Retired Spouse's Job Title* Spouse's Employer Name* Spouse's Employment Address* Street Address Address Line 2 City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Retirement Date Banking InfoOptional: This allows you to electronically move funds to and from your bank and your brokerage accounts securely.Enable ACH / Electronic fund transfers? Check here if you would like to electronically move funds to/from your bank and brokerage accounts Bank Name* Name on Bank Account* ABA Routing #* Bank Account #* Qualified Retirement Plan Investments & Assetsex. IRA, 401(k), 403(b)Value of Traditional IRAs:Value of Traditional IRAs Spouse:Value of Roth IRAs:Value of Roth IRAs Spouse:Value of 401(K)s with Current Employer:Value of 401(K)s with Current Employer Spouse:Value of 401(k)s with Former Employer(s):Value of 401(k)s with Former Employer(s) Spouse:Value of 403(b)s:Value of 403(b)s Spouse:Value of SEP & Simple IRAs:Value of SEP & Simple IRAs Spouse:Value of Pension Plans:Value of Pension Plans Spouse:Value of Other Retirement Plans:Value of Other Retirement Plans Spouse:TOTAL of Qualified Investments & AssetsNon-Retirement Investments & AssetsNot in any type of IRA or account listed previouslyValue of Checking:Value of Checking Spouse:Value of Checking Joint:Value of Checking Other:Value of Savings:Value of Savings Spouse:Value of Savings Joint:Value of Savings Other:Value of Money Markets:Value of Money Markets Spouse:Value of Money Markets Joint:Value of Money Markets Other:Value of CDs:Value of CDs Spouse:Value of CDs Joint:Value of CDs Other:Value of Annuities:Value of Annuities Spouse:Value of Annuities Joint:Value of Annuities Other:Value of Brokerage Accounts:Value of Brokerage Accounts Spouse:Value of Brokerage Accounts Joint:Value of Brokerage Accounts Other:Value of 529 / Education IRAs:Value of 529 / Education IRAs Spouse:Value of 529 / Education IRAs Joint:Value of 529 / Education IRAs Other:Value of Limited Partnerships:Value of Limited Partnerships Spouse:Value of Limited Partnerships Joint:Value of Limited Partnerships Other:Value of Other Investments:Value of Other Investments Spouse:Value of Other Investments Joint:Value of Other Investments Other:TOTAL of Non-Qualified Investments & AssetsOther AssetsValue of Personal Home:Value of Investment Real Estate:Value of Businesses Owned:Value of AutomobilesValue of Other AssetsTOTAL of Other Assets Short Term & Long Term LiabilitiesTotal Personal Home Mortgage Debt:Total Automobile Debt:Total Credit Card Debt:Personal Loans:Total Investment Real Estate Mortgage Debt:Business Loans:Other Debt:TOTAL Liabilities and DebtNet WorthLiquid Net Worth Incomeplease list all income sources (annually not monthly)Earned Income*Earned Income Spouse*Estimated ExpensesTotal Estimated Monthly Expenses GeneralAre you anticipating any major lifestyle changes? Yes No i.e. Marriage, Divorce, Retirement, Moving, etcWhat changes are you expecting? Do you anticipate any significant changes in your cash flow? Yes No Do you anticipate any major expenditures in the near future? Yes No What expenditures are you expecting? examples: auto, major vacation, medical, home, investment, business...Retirement PlanningAre you currently retired? Yes No At what age do you expect to retire? Is your spouse currently retired? Yes No At what age does your spouse expect to retire? What minimum annual income do you need (in today's dollars) to retire?Are you covered by any company pension plans? Yes No Risk ManagementDo you have any potential health problems? Yes No Do you have long term care insurance? Yes No Do you have an Emergency Fund (money set aside in savings)? Yes No Amount in Emergency FundIf unsure of exact amount, please provide an estimateDo you have life insurance? Yes No Total Death Benefit Amount of all policies:If unsure of exact amount, please provide an estimateTotal Death Benefit Amount of all policies Spouse:If unsure of exact amount, please provide an estimateWhen were your life insurance policies issued? Enter approximate dates if unsureEstate PlanningDo you have updated / adequate wills? Yes No Uncertain Have you established any trusts? Yes No Uncertain Are you the beneficiary of any trusts? Yes No Uncertain Will you be receiving a significant inheritance soon? Yes No Uncertain Estimated Amount:Estimated Date:Less than a month1-6 months1-3 yearsFinancial PlanningWhat types of financial planning will you need? Select All Retirement Planning Social Security Planning Company Retirement Plan Review Values Based Investment Planning Investment Risk Assessment Tax Planning Educational Funding Life Insurance Planning Estate Planning Long Term Care Planning Investment Real Estate Analysis Major Purchases & Planning For Future Expenditures Creative And Deferred Gifting Strategies Planning For Sales of Major Assets Planning For Possible InCapacity Proper Titling and Beneficiary Designations Collaboration with CPA and Attorney Multigenerational Family Planning Personal Document Digitization Asset Protection Planning Cash Flow and Debt Planning Net Worth Statement Ongoing Financial Guidance Check all that applyTax PlanningWhat were your total income taxes last year?Do you work with a CPA or Tax Advisor to prepare your federal income taxes? Yes No Do they annually check for tax savings strategies? Yes No Uncertain Are you interested in exploring tax savings strategies? Yes No Uncertain Multi-generational Planning70% of money inherited by the first generation is gone within 5 years. The remainder is gone by the second generation.Have you considered the impact of how a substantial inheritance may positively or negatively impact your children and/or grandchildren? Yes No Uncertain Are your children and/or grandchildren mentally prepared and capable of receiving their financial inheritance? Yes No Uncertain Would you be interested in discussing multi-generational planning? Yes No Uncertain Would you be interested in possibly setting up a family foundation? Yes No Uncertain Personal and Moral Investment RestrictionsPlease list any industry, sector, social, or company specific restrictions that you would like to restrict on your accounts. CIS will work diligently to help you to fulfill this request whenever possible.Common restriction examples: Select All Abortion LGBT Adult Entertainment Alcohol Tobacco Stem Cell / Fetal Tissue Research Gambling Other a complete list of industries is available upon requestList other restrictionsSecurity type, Industry, Category or Stock Name / TickerPhoneThis field is for validation purposes and should be left unchanged.
